The Double-Edged Sword Behind Quality Metric Reporting

By | October 24, 2023

In our unwavering commitment to delivering high-quality healthcare, the industry has seen an influx of quality metrics implemented by government agencies and private payors. While the intention behind these metrics is commendable, we must pause to reflect on their actual value, as the costs associated with their implementation can potentially worsen the care they seek to improve.

A recent study published in the Journal of the American Medical Association, titled “The Volume and Cost of Quality Metric Reporting” by Saraswathula et al., has shed light on the staggering expenses incurred in pursuing quality metrics. This eye-opening research conducted at a large health system revealed that across six months, the cost of collecting and reporting on 162 metrics amounted to a jaw-dropping $5M. To compound this financial burden, an additional $600,000 was spent on vendor fees. These metrics span a range of categories, including claims-based and chart-abstracted metrics, with only four metrics being electronically measurable. Each metric came at a considerable annual cost.

The fundamental question arising from this situation is whether these metrics, regardless of cost, lead to improved outcomes, enhanced quality of care, or increased patient safety. But let’s momentarily set aside this debate and focus on the bigger picture.

The financial burden becomes astronomical when we extrapolate these costs from a single health system to the entire healthcare landscape. These expenses, ultimately, are borne either by healthcare institutions or by patients in the form of higher cost, reduced affordability, and compromised care.

Furthermore, the discrepancy in cost between metrics electronically reported and those that require manual collection is substantial. This variance underscores the importance of electronic reporting to mitigate costs and allocate resources more efficiently.

To prioritize value-based care, which encompasses both quality and cost considerations, we must critically assess what we measure and how we measure it. We must constantly ask ourselves whether a metric genuinely influences care delivery and if the cost of measurement justifies its impact on the overall healthcare equation. Notably, within the Medicare Shared Savings Program, metrics requiring reporting have been reduced in response to these very concerns. Metrics deemed less impactful have been eliminated, and their replacement occurs only if proven beneficial. Additionally, conducting a cost analysis for each metric becomes imperative, with electronically collected metrics offering a more cost-effective alternative.

In our relentless pursuit of quality, we must strike a delicate balance between cost and quality, even as we engage in quality metric reporting. Let us adopt a holistic approach to defining the metrics that genuinely matter, devising efficient collection methods, and acknowledging that the cost directly affects patient care and services.